P1081: PET-ADAPTED THERAPY AFTER THREE CYCLES OF ABVD FOR ALL STAGES OF HODGKIN LYMPHOMA: LONG TERM FOLLOW UP OF THE GATLA LH-05 TRIAL
Authors: A. Pavlovsky, N. L. Fiad, M. V. Prates, I. Fernandez, N. Kurgansky, A. Cerutti, F. Sackmann, F. Negri Aranguren, P. Negri Aranguren, G. Remaggi, L. Ferrari, R. Mariano, L. Guanchiale, J. Maradei, F. Giuliani, E. Roveri, A. Enrico, S. Zabaljauregui, M. D. R. Cabrejo, C. Gumpel, A. I. Varela, M. Riddick, S. Pavlovsky
Journal: HemaSphere (2022)

Background: PET-CT adapted treatment for first line Hodgkin Lymphoma has been widely studied in the last decades. Long-term follow-up is important to judge both effcacy and safety of this approach. Aims: Evaluate the efficacy of the PET3 adapted treatment in patients with classical Hodgkin’s lymphoma (HL) in Ann Arbor stages I-IV. Methods: We analyzed updated follow-up data on all patients (pts) treated within the LH-05 GATLA trial. Newly diagnosed pts with HL Stages I-IV were included. All patients received 3 ABVD and were evaluated with a PET-CT-3 (PET3). Pts with a negative PET3 (DS 1 and 2) were consideredin metabolic CR and received no further therapy. Pts with DS 3 and 4 completed 6 ABVD and IFRT on PET-CT positive areas. Pts with progressive disease (DS 5) after 3 ABVD received salvage chemotherapy. We present the updated results of 490 pts with a median follow-up of 10 years. With a median age of 35 yrs., 300 presented with localized stage and 190 with advanced stage. Results: In LH-05, of all pts, 338 (69%) achieved CR with negative PET3, 152 (31 %) were PET3 positive. With a median follow up of 120 months the PFS and OS for all pts at 5 years is 79.2%and 94.3% respectively. Pts with negative PET3 had an PFS of 89% and 80% for localizedand advanced stage, compared to 63% for all pts with positive PET3 (p <0.0001). We performed a multivariate analysis for PFS which included age, stage, IPS, bulky disease, extranodalareas and the result of the PET3. This last parameter, together with age, were the only ones with statistical significance (p=0.001 and 0.046 respectively). Stage at diagnosis was not significant. With long term follow up the OS at 5 years is 97.3% and 87.3% for all PET3 negative vs PET3 positive pts. When comparing the results LH-05 with our previous clinical trial (LH-96) there is no difference in PFS and OS at 5 years but in LH-05 only 31% received more than 3 cycles of ABVD and IFRT compared to 61% and 100% in LH-96. This PET adapted approach reduces exposure to chemo andradiotherapy with no negative effect on long term outcome. Image:Summary/Conclusion: This long term follow up data support the PET-CT adapted approach for all stages ofHL after a short course of ABVD. In the Cox regression model, PET-CT at completion of treatment was the most significant factor associated to PFS. Treatment with 3 cycles of ABVD can be adequate for pts with negative PET3 regardlesstheir stage at diagnosis. Nevertheless, this long term follow up demonstrated that there is still a room for improvement trying to identify PET3 negative pts that will relapse and escalating treatment in PET3 positive pts to improve outcome. GATLA is designing a trial with the aim to improve these two different risk groups.